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Not sure if this affects everyone but the deadline in CT is Dec. 15th if you need insurance by 1/1/2014. Might be important to find out depending on your own situation.

Tried today to get quotes. No luck yet. Expected glitch. I'm sure it will get smoothed out.

I am hoping that the ACA proves SO successful in those of the states that tried their best to implement it that it will shame the other states to take better care of their own citizens. Not sure if it's realistic. I wish the best to those of you living in one of these states. So sad.

here in SC they passed a law banning any state employees from implementing any of the ACA, so there has be NO pre-planning or training about the Marketplace or the insurances available. my SC HIV Task Force joined with our allies at Harvard Law and have held a special training of case-managers on the ACA, Marketplace and how to evaluate insurance plans. It was SRO and quite a success as we had case managers from agencies (mostly NON-HIV!) from all over the state. The Task Force has also "hired" a special consultant/training to assist our ASOs since the State won't and the Feds can't.

That's why the official SCHTF position is for all HIV poz people needing insurance to consult with their case managers and to WAIT all long as possible, until the situation can be properly assessed to get the best coverage for our clients.

I was impressed . I could buy the silver plan for $1300 a year if I wasn't already insured .

wow. I'm just hoping to get a plan comparable to what I've got now, but cheaper, much cheaper. Currently pay around $12,000 per year and have already paid well over $3000 out of pocket thus far. (not to mention another $5-6000 in dental bills .)

PS- I have a zero deductible policy. Out of pocket costs were for co-pays.It really was my best option.

It allows me to create a name and password but won't show me the security questions I need to answer. Live chat is down. I guess I'll wait until the traffic slows down.

The president said today that more than a million people were already on the federal govt site by 7am. He said that's more than Medicare.gov sees in an entire day. He said they are working on getting that fixed. So, I imagine the state websites are just as clogged.

I'm sure most here know all these, but interesting anyway. There were a few I was uncertain about. Sarah told me there were death panels, and I always listen to her. No, I was unclear whether Congress was exempt.

And that's causing the federal government to have to come in and handle it. This is true for Indiana. And, this makes the premiums more expensive in those states, no? I thought I read Indiana premiums would cost more, due to the state Republicans acting so childish.

And that's causing the federal government to have to come in and handle it. This is true for Indiana. And, this makes the premiums more expensive in those states, no? I thought I read Indiana premiums would cost more, due to the state Republicans acting so childish.

Ted, yes, the state did not implement any state run exchanges. For our clients, most that are not on Medicaid/Medicare have the insurance called ichia, which will dissolve at the end of the year. However, they will roll into adap/eip, then starting April one ISDH (Indiana State Dept of Health) will have contracted with an insurer similar to ichia. And there is -0- premium, deductible, or co-pays to the clients. They have to be within 300% of the FPL, which is pretty good actually. I believe I said this in a similar post.

At the training I went to last week in Indy, there was a lady there from, like Indiana Insurance, or some such. She talked about the different plans, and a few facts. Most of our clients are not affected. I have very few clients covered on their employer's insurance. Most are either on Medicaid, Medicaid/Medicare, or ICHIA.

Indiana did screw themselves. Pence wanted to expand HIP but that's not going to happen from what I heard. I was told that the higher-up's in Indiana are watching (of all places) Arkansas, and how they are going to implement expanded Medicaid in their state. Indiana still does have the opportunity to expand Medicaid at whatever point they think they should (which should be right now!).

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

I just tried to modify this and it didn't take. Anyway, we'll see if this works. When EIP and ADAP take back over the only benefit people will not have is hospital or ER. But, when the state contracts with another insurer that will be re-instated. Clients can get dental, mental health coverage, and with EIP, even vision. A single person can make up to $32,000 a year and get this benefit, with -0- out of pocket for premiums, co-pays or deductibles. Not a bad deal really considering it's Indiana.

« Last Edit: October 01, 2013, 06:04:00 PM by BT65 »

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Not sure if this affects everyone but the deadline in CT is Dec. 15th if you need insurance by 1/1/2014. Might be important to find out depending on your own situation.

those deadlines are the national deadlines set by the ACA.

Technically you can still enroll up until Mar 15th 2014. However when you sign up between 12/15/13 and 3/15/14, the date the policy goes into effect is NOT 1/1/13. (it's delayed but I don't remember that date off the top of my head. you'd like I would after talking to so many groups about this LOL)

actually was really horrifying is when I compared the original draft of HR 3101 (the SC house resolution to enforce state employees from implementing Obamacare) to the SC Declaration of Session 1852. The documents read pretty similarly: SC is a sovereign state, 10th amendment, 4th amendment, states rights, blah, blah blah. and then either "we don't want to abolish slavery" or "we don't want obamacare".

god/karma/buddha/jebus/somebody! save us from the SC Tea Party wingnuts!

Technically you can still enroll up until Mar 15th 2014. However when you sign up between 12/15/13 and 3/15/14, the date the policy goes into effect is NOT 1/1/13. (it's delayed but I don't remember that date off the top of my head. you'd like I would after talking to so many groups about this LOL)

gosh! I had typed 2015 at one point and then something else. My fingers kept typing stuff my brain wasn't thinking LOL. Thanks for the catch! So Yes, this upcoming New Years Day of 1 /1/2014 is the date these marktetplace policies will start if you enroll in this December 12/15/13, just before Christmas;)

god/karma/buddha/jebus/somebody! save us from the SC Tea Party wingnuts!

or angry mobs. feel bad that the mentality of the politicians and the gerrymandering that keeps them in office makes people suffer so much. each decade that goes by seems to bring more challenges to the average citizen. the pressure cooker is heating up once again.

it all depends on the plans offered from state to state. and from plan to plan.

I guess a better way to frame the question would be does the maximum out of packet expense a year apply to prescription drugs as well . I ask because many people cant afford treatment even with insurance due to copays .

I guess a better way to frame the question would be does the maximum out of packet expense a year apply to prescription drugs as well . I ask because many people cant afford treatment even with insurance due to copays .

Tried to find out who to talk to in person about all of my questions but there was a glitch in the system to provide me with a connection. Will keep trying but it looks like both Kenny and I will end up saving many thousands of dollars.

When I get this all figured out I will certainly be posting the results.

Oh, I saw this on the Today Show. They ran numbers for Connecticut. A family of four making $50,000 a year could get Silver coverage for $178 a month. Their deductibles would max out at $5,000 and their out-of-pocket costs would max out at $10,400 per year.

Ok, that premium is very affordable. That deductible is high. But, I've read not all services are necessarily subject to deductibles. I would like to know more about that. Do you have to pay $5,000 out-of-pocket, before insurance pays doc visits and prescriptions? That's steep. Is that what this means? It would be great for a serious illness, where you rack up tens of thousands of dollars in bills. $178 a month is affordable, if it ensures you don't go bankrupt over a costly hospitalization, surgery, or serious health issue.

I really wonder what's going to happen to the people on ADAP and Ryan White.

The law requires that everyone buys insurance and if you don't then you will be charged a fine. So, if your on ADAP that would mean you don't have insurance. So will you be forced to buy insurance effectively removing you from ADAP coverage?

Most states will be expanding Medicaid coverage to include people who are now on ADAP which would be beneficially for them since Medicaid would cover more than just HIV related issues.

But what happens if your in one of the states that threw up their middle finger to the Feds?

I am currently on NHCARES aka as "ADAP/Ryan White" in my state. I'm on a transitional health care plan funded on the federal level and it will expire at the end of the years. My ASO in conjunction with the NHCARES will help me find a new health care plans and will pay any premium or copay as long I a continue to qualify for the program. Also today I got a notice that they are raising the qualification level to 400 percent of the poverty level effective right now. That raises the income level for a single person from 34,470$ to 45,960$ and a married couple from 46,530$ to 62,040$. Not sure if this is a change on the federal level or just on the state level here. Just learning how all this actual works.

I have also be asked to join a committee with the Health and Human Services in my state. I'm told it is a requirement for the state to receive federal funding and they have now opened these committees up to people living with HIV. Anyway I'll be attending a meeting on November 15Th and there will be a presentation on the Affordable Heath Care Law and what it mean to people living with HIV. I hopping to gain a better understanding and I share any information that I may get.

**added**I'm in a state that has yet to decide if it will expand Medicaid

That is no news... This is a culture war, been building for years and years... One of the leftist talk show (Bill Maher? ) presented a series during the last Presidential election cycle, on health care, welfare, etc, in poor areas of the south. It was extremely sobering... All about the idea of entitlement and also the grossly underserved.... People have been brainwashed or squashed so low and marginal, they don't realise what a scandalous lot in life this is, for a rich country. And then other people pointing fingers.... And the prediction that some states will face the future and win, delivering a better society, and some are on a fast road to poverty, ill health, misery and insecurity. Some states will be banana republics resembling third world countries. Others will be more like scandanavia.

« Last Edit: October 03, 2013, 06:53:57 PM by mecch »

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Those revolting, depressing "people's testimony" ads in the beginning of Romney's campaign. "I work two jobs, have no savings, have no health insurance, my kids have no future, my cars a wreck and my teeth are falling out. But I don't complain and I don't think my government owes me anything. That's what makes me a GOOD AMERICAN. Any contrary thought is immoral, atheistic, communism. "

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Um k. 'Cause I'm sure it's his fault that the site is being swamped and or glitchy

Been on the "wait here" page for 1 hour, but it finally flashed up and said "In a hurry? You might be able to apply faster at our Marketplace call center. Call 1-800-318-2596 to talk with one of our trained representatives about applying over the phone."

Um k. 'Cause I'm sure it's his fault that the site is being swamped and or glitchy

Been on the "wait here" page for 1 hour, but it finally flashed up and said "In a hurry? You might be able to apply faster at our Marketplace call center. Call 1-800-318-2596 to talk with one of our trained representatives about applying over the phone."

I talked to Paul (who sounds sexy btw), I told him I am not sure I wish to sign up yet but wanted to get some quotes. He told me I would have to do that on the website (which is what I figured he would say).

Kentucky has gotten national attention, for how we are one of a couple red states fully implementing the law with the Medicaid expansion. And, how enrollment has gone smoothly. It is interesting how some believe there are 2 options-- a regular healthcare benefit and "Obamacare." Jimmy Kimmel interviewed people on the street to ask whether they preferred the Affordable Care Act plan or Obamacare. Many said they wanted no part of Obamacare, but liked the Affordable Care Act plans. Yes, those are small samples, but I think this thinking is common.

With Pennsylvania, I thought they were just not expanding Medicaid, but it seems they also didn't set up the exchanges, leaving it to the federal govt to do?? And, I heard many think marriage equality has a good chance of becoming reality there soon. Does the governor have sole discretion on whether to implement the healthcare law? Or, did the legislature have to vote on it?

I kinda wish all the sates let the feds set up the exchanges , that way it will be easier morph to it into a single payer system if they are all managed and regulated by the feds and not state by state , if that time ever comes .

I know this is a huge leap of imagination from what's really going on but just saying .

Anybody have any idea what the drug plans on these exchanges are like for hiv medications. I was just looking at united health care plans from their site, they show most hiv drugs in tier 4 which shows 25% coinsurance. That would seem expensive for 3 medications when looking at 1000 per month for each drug

Anybody have any idea what the drug plans on these exchanges are like for hiv medications. I was just looking at united health care plans from their site, they show most hiv drugs in tier 4 which shows 25% coinsurance. That would seem expensive for 3 medications when looking at 1000 per month for each drug

I just checked several plans offered in CT and it seems they are all over the map. I was able to find one with no coinsurance for tier 4 drugs.I think all of the benefits across the board are going to vary state by state, insurance co. by insurance co. I don't know how ADAP works in other states but here in CT you can have insurance and still have ADAP. ADAP covers any co-pays that the primary insurance company doesn't.

ADAP, by law, must be "payer of last resort" so I suppose they could have ADAP pick up whatever isn't covered in these exchange thingies. If any particular state doesn't do that then it just means the state you live in sucks and you should move.

I think all of the benefits across the board are going to vary state by state, insurance co. by insurance co. I don't know how ADAP works in other states but here in CT you can have insurance and still have ADAP. ADAP covers any co-pays that the primary insurance company doesn't.

It's always been possible to have insurance and ADAP (if you are financial eligible). Often ADAP is then able to just pay a premium or a co-pay amount and not have to fund a patient's entire medication bill.

ADAP monies will eventually (in the future) be funneled into the ACA and Medicaid Expansion programs; as will indigent funds paid to hospitals to cover those who cannot afford to pay. This is why the "defunding" arguement of the Republicans is so crazy. Most of the ACA is actually already paid for by funds that were spent elsewhere. All these monies which were funding people's healthcare will just be put into a different account and will still fund people's healthcare.

But in the meantime, as payer of last resort, ADAP will become a wrap-around program, filling in the gaps (co-pays, premiums, emergencies, etc) as people get insurance or get onto the Expansion program. Of course, in the states that didn't accept Medicaid Expansion, ADAP will very much be needed in the next few years to pay for a LOT of health care.

For those people having a hard time finding an appropriate plan, you should contact your case manager to get in touch with a Navigator. There are people funded in every state to help clients navigate through the Marketplace. These Navigators have been trained and (should) have evaluated the plans available in your state and should be able to point consumers to the plans that would be best for HIV positive clients.

I kinda wish all the sates let the feds set up the exchanges , that way it will be easier morph to it into a single payer system if they are all managed and regulated by the feds and not state by state

there's a problem with this idea though. In states that have not accepted medicaid expansion or created their own marketplace, consumers will only have federally approved plans available to them. For example, people in both North and South Carolina, neither one which accepted ME or a state-run Marketplace, only have access to Federal plans - plans based on averages across all the states. This means consumers in these two states will be paying more because none of the plans have been tailored to either state. If the plans had been tailored, they would have cost less as our costs here are less than in some other states.

Leatherman, I was just about to post this, when I saw your post. I think you answered my last question.

At my HIV doc, I stopped in to say hello to my old ADAP coordinator. When I was dx'd, I had to sign up for it, but never used it and then took myself off the rolls when I got insurance.

Anyway, I overheard him telling someone on Medicare getting the "extra help" that if he ever makes above the limits for the extra help, they would take over and pay the deductibles, premiums, etc. Volunteers of America runs ADAP here.

This got me wondering whether they would help pay the premiums, deductibles, and co-pays, for those getting insurance through the new exchanges. I was on my way out, when I heard the part about paying the Medicare premiums, so I didn't get to ask him. I will have to ask next time I'm there for my flu jab.